Science, Politics or Economics?
Contrary to popularly held beliefs, modem medicine is often based as much on philosophy, beliefs, politics & economics as it is on science. Perhaps no story better illustrates the tapestry interwoven by science, politics and economics than that of Dr. Erdem Cantekin, former director of a research center at the University of Pittsburgh. Dr. Cantekin, an international authority on ear disease, was co-investigator on a five-year National Institutes of Health study to evaluate the effectiveness of the antibiotic amoxicillin in the treatment of childrens ear infections. Americans spend over $500 million annually to treat this one condition.
Cantekins analysis of the data from this study showed that amoxicillin was ineffective and possibly harmful. His findings were further analyzed and corroborated by a statistical analyst from Carnegie Mellon University. But another researcher disagreed. According to an article entitled "Corporate-Funded Research May Be Hazardous to Your Health" published in the Bulletin of the Atomic Scientist, "the primary investigator on the $15 million federal grant, a colleague of Cantekins at the medical school interpreted the data differently: after changing the study protocol, he determined that amoxicillin is effective against childrens ear infections." [emphasis added]
"The primary investigator had also, over the period when the government was paying for the research, accepted perquisites amounting to over $50,000 per year in lecture fees and travel money from drug companies that produce antibiotics. Between 1981 and 1986, the ear center received more than $1.6 million in research grants from pharmaceutical companies to test the effectiveness of antibiotics on ear infections."
Dr. Cantekin wrote a paper arguing that amoxicillin "while appropriate for many uses, is not effective in the treatment of secretory otitis media [fluid behind the ear drum]." He submitted his paper for publication in hopes that other physicians could view his interpretation of the research and compare it with that of his collleague. But this was not to be. Both the New England Journal of Medicine and the Journal of the American Medical Association rejected Dr. Cantekins paper. Meanwhile, the paper presented by his colleague, which supported antibiotic use, was published in the New England Journal of Medicine (1987). Antibiotic sales soared following publication of this paper.
This case is filled with tragic irony. As a result of Dr. Cantekins efforts "his data tapes were erased, he was taken off all the departments grants, fired as director of the ear research clinic, and forbidden by the chairman to publish the paper. . . . Because he has tenure the School of Medicine cannot fire Cantekin, but he has been stripped of the resources needed to conduct research."(1,2) Sadly, as a result of these actions physicians throughout the United States were deprived of the opportunity to base their judgment on conflicting viewpoints, and were left to ponder only that which supported the prevailing belief.
Nearly five years later, Dr. Cantekins paper was finally published in the Journal of the American Medical Association (December 1991). The results have seriously challenged the prevailing belief about the value of antibiotics in treating ear infections, especially those that are chronic. Cantekins data showed that not only did children on amoxicillin fare no better than those taking placebo (sugar pill), but those on amoxicillin suffered from two to six times the rate of recurrent ear effusion. Cantekin also remarked on two other popular antibiotics. He wrote, ". . . those data indicate that amoxjcilljn was not effective and that two other antibiotics, Pediazole and cefaclor, also were not effective according to the method of analysis the OMRC [Otitis Media Research Center] had chosen to use."(3) It is interesting to note that the "negative" data regarding Pediazole and cefaclor was never published by the original investigators, but came out during a Congressional investigation.